ABSTRACT
Purpose: Pancreas transplantation (PT) is the best long-term option for patients with labile diabetes and end-stage-renal disease. The mortality on the waitlist is high;patients should receive a transplant as early as possible. There remains a shortage of high-quality organ donors suitable for pancreas (and kidney) transplantation. PT in HCV positive recipients using a negative donor (R+/D-) has been performed but not vice versa (no R-/D+ transplants). After the advent of new, oral, and directacting antiviral agents, the option to use HCV+ deceased donor organs has become possible;anti-HCV treatment is started right after transplant. Method(s): All reported cases of R+/D- and R-/D+ transplants performed since 1/1/2019 were included in this study. Descriptive analysis of patient, donor characteristics, and outcome was performed. Patient and graft survival was assessed using the Kaplan-Meier method. Result(s): 38 R+D-, 36 R-D+, and 2 R+D+ transplants were identified. The majority were simultaneous pancreas kidney (SPK) transplants. Only one R-D+ pancreas after kidney transplant (PAK), and 8 pancreas transplants alone (PTA all R+D-) were performed. Tables 1 and 2 show donor and recipient characteristics for SPK transplants. The donors were excellent young donors, mostly males dying of trauma, but, in the R-D+ category, in the majority previous drug users. Notably, the waitingtime for R-D+ recipients was under 3 months in 50% of transplants. Outcome of the HCV NAT test at 6 months is shown in Table 3. The 2 positive patients at 6 months were negative at 1 year follow-up. Patient and graft survival is shown in Table 3. The 3 early deaths in the R-D+ group were 1 trauma, 1 bacterial infection due to technical problems, and 1 possible COVID-19 infection. All 3 patients died with functioning pancreas and kidney grafts. Conclusion(s): Pancreas transplantation is considered by many a non-life-saving procedure and, therefore, patients and donors are carefully chosen. What is neglected is the fact that the mortality of diabetic patients while waiting is high. Hence, it is essential to transplant as early as possible. In contrast to solitary pancreas transplants, the SPK waiting time is long. The advent of new HCV treatment modalities makes safe and successful transplants possible for HCV+ recipients and from HCV+ donors possible. HCV+ donors are usually young and excellent donors who fulfill acceptance criteria for pancreas transplantation. Follow-up time for patients in this study is short, but our preliminary results show that the use of an HCV+ donor results in safe and successful pancreas transplant outcome.
ABSTRACT
Purpose: Over the last years, the number of kidney transplants from living donors (LD) increased. However, more male than female patients received a LD transplant while increasing more females donated a kidney. Method(s): This study included all 109,038 primary adult living donor kidney transplants reported to UNOS/OPTN and performed between 2000 and 2021. To account for annual fluctuations, 2-year intervals were assessed. Comprehensive univariate and multivariate analyses were performed to describe changes and risk factors for female living donor kidneys transplants. Result(s): Figures 1 and 2 show the proportion of female donor and kidney recipients over time. Table 1 and 2 show the gender differences for donor and recipients. Women continued to donate more even during the COVID-19 years 2020/21. For female kidney recipients increased the relative disparity index constantly from 1.39 in 2000/01 to 1.75 in 2020/21. The likelihood for a woman to receive a LD kidney increased by not having diabetes as underlying disease, being Black , and having a high PRA level, and being not working;the likelihood decreased with increasing age and being on dialysis. almost 3 times more often donated female spouses a kidney. Conclusion(s): (1) the disparity of receiving a LDK has continued in favor of men;(2) the likelihood to receive a LDK kidney was higher for a black vs white woman;(3) the likelihood to receive a non-biological LDK (spouse) was significantly lower for women vs men;(4) while women are significantly more often sensitized, the likelihood to receive a LDK was higher for sensitized women vs men. Gender disparity in 2020/21 remains real in LDK transplantation. (Figure Presented).
ABSTRACT
Background: Detrimental impact of COVID-19 on renal function unraveled over time. Nephrology community was in a dilemma whether transplantation should continue under such circumstances. We investigated which States within the US continued to perform kidney transplantation despite such odds. Methods: Retrospective data from Organ Procurement and Transplantation Network (OPTN) regions for kidney transplant alone (KTA) performed across the US from 2019 to 2020, reflecting the peak of the first wave of COVID -19 pandemic were analyzed. To address whether the COVID-19 had an impact on transplanted kidneys, we analyzed graft survival at 3-and 6-months post-transplant during that era. We further investigated the statewide variation of KTA in both deceased donor (DD) transplants and living donor (LD) transplants. Results: There was a 3.1% decrease in KTA from 2019 to 2020 (22,429 to 21,731). There was an overall trend of a decrease in number of transplants across all states with a peak decline in March-April 2019 era and rebound in May 2019 onwards. Statewide regional decline or variation of DD KTA was most significant in region 9 (NY, Vermont) while regions 4 (Oklahoma and Texas) continued to perform transplants unabated. In 2019, 30.6% of KTA were from LD while in 2020 the rate decreased to 24.1%. The transplantations of DD increased from 15,562 to 16,497 in 2020. Overall, 3-month graft survival was significantly negatively impacted for DD KTA performed between February and May. The decrease in KTA in the southern regions was less compared to the northeastern regions. Conclusions: The COVID-19 pandemic had a major impact on kidney transplantation with a significant reduction within all OPTN regions. While LD transplantation could presumably be rescheduled, DD organs must be procured immediately, or they are lost. Therefore, the number of DD transplants decreased initially between March and May but recovered afterwards. Transplanted kidneys during COVID-19 first wave pandemic era performed reasonably well but with an increase rate of injury and rejection.
ABSTRACT
Background: Corona Virus Disease-19 (CoVID-19) infection associated with AKI and ARDS results in a mortality of 80%. In AA population COVID 19 presentations and outcomes are worse. NIH and Interim WHO guidelines suggest against steroids use unless in the context of clinical trials. We conducted a retrospective analysis on the impact of 2 different doses of IV steroids in AA adult population. Methods: 75 patients between March 1 and April 30, 2020 were enrolled. Primary outcomes (21-day mortality) and secondary outcomes (improvement in lung function and renal function) were analyzed. Comparisons between the steroid doses (methylprednisolone 1 mg/kg/day or 2 mg/kg/day) and no-steroid groups were performed with the Wilcoxon, Kruskal-Wallis, and Chi-Square tests. Factors affecting the recovery of AKI or ARDS were analyzed. AKI recovery was defined as 50% increase of GFR, and cessation of RRT;lung function recovery was defined as improved oxygenation by P/F ratio > 200 and extubation. Results: 38 out 75 patients received steroids. Survival in the steroids group reached 73% at 21 days compared to 36% in the non-steroids group (p<0.0006). Steroids improved the likelihood of renal function improvement by 300% (p=0.06). Lung functionwas 73% in the steroids group versus 45% in the other (p=0.01). Use of anticoagulants (16% vs 51%, p= 0.001) seemed to be interacting with steroids on outcomes. Low dose steroids had the most beneficial impact. Conclusions: In patients with COVID-19 infection and ARDS with AKI, low dose IV methylprednisolone was associated with a significantly lower incidence of mortality and higher likelihood of renal and lung function recovery. Further investigation with a randomized control trial consisting of low dose steroids seems warranted. (Figure Presented).
ABSTRACT
Background: HD units are clustered close contact environments where prolonged and repeated exposure to blood borne pathogens occurs. Weeks into the CoVID-19 pandemic, wide disparities in rates of death and exposure of staff and patients amongst HD units in the same zip code of an epicenter in New York regions emerged. Methods: Random HD units surveyed as to when and what infection control measures they implemented. Direct input into RedCap and SAS 9.0 analysis of the data conducted. Results: 15 HD units (average census 18-240) responded. Survey compiled exposure rates from 3/1/20 - 4/30/20. The 1st reported case of CoVID-19 by a facility was 3/2/20. Most facilities reported outbreaks (4-30 cases per facility) by 3/21/20. Missed HD sessions due to CoVID varied from 2-100, hospital stays for such patients varied from 2-20 days and death rates from 0-15 per facility. 4 of 15 facilities reported deaths of family members of exposed patients and impediments in logistics of single person transportation forcing carpooling. Home dialysis programs reported minimal deaths and exposures. 20% of facilities had no infection preventionist and 26% no patient educator. Reported waiting area cleaning and hand sanitizer refill rates ranged from 1-5 times per day. 20% of the facilities have < 6 feet distance between patients. Implementation of infection control practices such as wearing of masks by patients varied widely amongst units. Some started March 1st-March 16th, some later due to mixed messages of its importance. Lack of personal protective equipment (PPE)(in 13% of facilities), staff, and housekeeping shortages (6.7-13.3%) compounded the problems. Positive CoVID results had 1-10 staff members infected per facility with sick call rates from 7-30 days, and no staff death. 46% of the HD units don't belong to the CDC coalition. Conclusions: Maintenance of strict hand hygiene, proper air flow, repeated environmental surface cleansing, availability of PPE, and patient and staff education remain the corner stone in preventing infections from spreading. Lack of leadership support and failing to share best practices between dialysis units in the US remains prohibitive but must be encouraged and standardized.